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Alexandra de Kiewit, a member of ADDICQ, poses outside their Montreal offices.Christinne Muschi/The Globe and Mail

With its glass walls and breezily painted street front, Cactus Montréal looks more like a community gym than what it is – a needle exchange that stands at the heart of a dispute over the future of Montreal's supervised drug-injection plans.

When the Supreme Court opened the door last fall to safe-injection clinics in Canada, health officials in Montreal expected to move quickly and follow the lead of Vancouver's Insite. Canada's second-largest city seemed like a natural location for such a service, with its high number of intravenous drug users and reputation for tolerant social attitudes.

But now health officials have sailed into political headwinds.

The Montreal health authority wants to set up a string of three sites across the city in locations that would include front-line community clinics such as Cactus, a long-established centre in downtown Montreal that already offer free needles to drugs users.

City hall is onside about spreading the sites out to avoid concentrating them in one place – but that is where agreement ends. Voicing concerns for public safety, Mayor Gérald Tremblay is saying no to Cactus, insisting that safe-injection services be run out of official health locales such as hospitals.

The mayor says the gritty pocket of downtown where Cactus is located is already overloaded with homelessness, mental-health problems and drug dealing.

"The neighbourhood already has too high a concentration of people in crisis," Mr. Tremblay said at a public meeting last month.

The stand has opened a breach in an already volatile issue. Health officials say it makes sense to put the new site where drugs users are (authorities also favour a mobile unit). A survey of intravenous drug users by health authorities last year found that only 37 per cent would use an injection site in a hospital, compared with 96 per cent in front-line locations like Cactus. The group's credentials, meanwhile, are indisputable: Opened 23 years ago, it was the first needle-exchange program in North America and currently gets 35,000 visits each year.

"There are community groups like Cactus that have proven themselves for over 20 years," said Carol Morissette of the Montreal Public Health Department, who is handling the supervised-injection file. "If the objective is to reach the greatest numbers possible, community groups are at the top of the list for providing services. They have the expertise ... we can't just set them aside."

Users support that view. Alexandra de Kiewit, who speaks for an advocacy group for drug users, says addicts avoid hospitals and other formal health-care settings.

"They get looked at funny, and judged," she said. At places like Cactus, she said, "they feel they have a relationship of trust."

Meanwhile, the mayor is facing pressure from residents and merchants downtown. Cactus is located on a commercial strip of Ste. Catherine St. E. that's got its share of panhandlers, sex workers and hard-drug users. But new condos are rising just two blocks away, part of city hall's efforts to lure families to central Montreal; and the city's vaunted entertainment district, Quartier des spectacles, is taking form only a few blocks west.

"We're worried about the honey pot effect," said Gaëtan Paquet, who speaks for a coalition of downtown residents who oppose the choice of Cactus. "People will come from Boston and Vancouver and say, 'Hey, let's go for a trip and shoot up.' "

The disagreement underscores the challenges facing Canadian cities as they try to follow in Vancouver's footsteps. The stakes are high, however. Louis Letellier de St-Just, the president of Cactus, says Montreal's handling of the issue is being watched not only in Canada "but around the globe."

"This is a concern in all the Western world," he said. "Quebec is considered progressive. All eyes are turned toward it."

Montreal will take its plans for approval to Quebec Health Minister Yves Bolduc, who has insisted that the proposal's prime criteria remains "social acceptability." An aide said in an interview that the minister wants to see all the players agree on a scheme.

In the heady aftermath of last September's Supreme Court decision, which ordered the federal government to let Insite keep operating and ruled that it had saved lives, Cactus officials said they hoped to open a supervised injection site in Montreal by spring. Now the most optimistic scenario is the fall.

"It's a marathon," Dr. Morissette said, "that we still hope to win."